Table 3.

Recommendations for Control of Methicillin-resistant Staphylococcus aureus in the Neonatal Intensive Care Unit

Recommendation Type	Consensus Recommendation
Hand Hygiene	A waterless, alcohol-based hand hygiene product should be available and easily accessible; soap and water should be used if hands are visibly soiled. Direct observation of hand hygiene practices and consistent enforcement of proper hand hygiene contribute to increased rates of compliance.
Cohorting and Isolation	MRSA-positive infants should be placed under contact precautions and cohorted; as should the supplies used in their care. Gloves and gowns should be worn when caring for MRSA-positive patients. Masks should be worn for aerosol-generating procedures, such as suctioning. Whenever possible, nurses should be cohorted for care of MRSA-positive patients.
Surveillance Cultures	Infants in the NICU should be screened periodically for MRSA colonization. Screening frequency should be adjusted based on unit transmission rates (i.e. weekly-monthly). Culture of nasopharyngeal specimens alone is sufficient.
Decolonization	Mupirocin may be used for decolonization of infants or healthcare workers if deemed necessary by the institution.
Molecular Analysis	When investigating an outbreak, a molecular epidemiologic tool such as pulse-field gel electrophoresis should be performed to assess the relatedness of strains found in NICU patients, healthcare workers, and the environment.
Communication	Open communication between regional NICUs is essential to prevent spread of MRSA between NICUs when patients are transferred to different institutions.

^*Adapted with permission from University of Chicago Press from Gerber et al.(11).